Assessing Underutilization of Mental Health Resources at a Historically Black College and University (HBCU)

Objective: In 2018, a survey was conducted with students on a Historically Black College and University (HBCU) campus that showed a significant lack of utilization of both on and off campus mental health resources. The primary outcome of this survey is to evaluate lack of utilization of mental health resources at an HBCU to effectively promote student mental wellness. Methods: A short electronic survey was administered to students to assess underutilization. Results: Subjects were predominately African American (60.24%) and female (85.53%). Of the 159 surveys completed, 13 responded they have used on campus mental health resources. Approximately 61.5% (8/13) are satisfied or very satisfied with the services. 29 responded they have used off campus mental health resources. Approximately 41.4% (12/29) are satisfied or very satisfied with the services. 62 (39%) responded that time constraint was a barrier faced in utilizing mental health resources. 60 (38%) responded that they did not feel that mental health resources were currently needed. 40 (25%) responded that they were not aware of mental health resources available. There is a significant association between classification and comfort level continuing to utilize mental health resources on or off campus (p = 0.02). Conclusions: There are multiple barriers that have attributed to the underutilization of mental health resources. According to the results of this survey, the majority of students lacked time to utilize or denied need for any mental health resources. These results will allow for an opportunity to improve utilization of both on and off campus mental health resources.


Introduction
According to National Alliance on Mental Illness (NAMI), in 2021 22.8 percent (57.8 million) of United States (US) adults experienced a mental illness; the annual prevalence is 21.4% in African Americans.47.2 percent of adults with mental illness received treatment, with treatment rates of 39.4 percent in African Americans.Treatment rates in women were reported as 51.4 percent, while male rates were 40 percent. 1 Results from survey data from the Heatly Minds Study between 2013 and 2021, which included greater than 350,000 students at 373 campuses, reported that greater than 60 percent of students in 2020-2021 met the criteria for one or more mental health problems. 2In the US adults aged 18-44, there are nearly 600,000 hospitalizations each year from mood disorders and psychosis spectrum. 1emographics have been linked to the utilization of mental health resources, with older adults being more likely to use resources. 3rriers have been attributed to the lack of utilization of mental health resources.Results from the WHO World Mental Health International College Student Initiative, which assessed barriers in rst-year college students, stated that wanting to handle the mental health problem alone, wanting to talk to family or friends instead, or being too embarrassed to seek help were all barriers rated the most important in college students. 4In a review conducted by Mahogany S. Anderson, it is stated that even if there are available and accessible resources, African American students are historically less likely to utilize them due to barriers such as stigma, cultural mistrust, or racial/ethnic identity. 3African Americans have also utilized coping mechanisms due to the lack of mental health resources available in the community.Another barrier that African Americans face is awareness.Awareness can be the lack of knowledge about mental health resources or the lack of awareness of the location of these resources in the community. 5ile all of these factors play a part in the overall cause of lack of utilization, each person most likely has their own unique reasoning as to why they do not or will not use the mental health resources that are available to them.The survey conducted through this research aims to examine exactly what that cause is and how students perceive their reasoning for underutilization.

Methods
A peer-reviewed literature search was done using Google Scholar and PubMed databases between 2001 and 2019.Keywords like "African American" "Mental Health" "Underutilization" and "Barriers" were used to narrow the search.A total of twelve articles were reviewed and determined to be in the scope of this literature review.One hundred fty-nine surveys were administered to students attending Xavier University of Louisiana to assess mental health resource utilization on campus.The surveys were administered to students throughout the university on a volunteer basis without regard to classi cation.Each student completed a ve-questionnaire survey comprised of questions assessing mental health resources on/off campus, preferred mental health resources, and students' likeliness to continue utilizing resources.

Study Design
This was a focused, online survey-based study conducted from September 2022 to November 2022 of students who attended Xavier University of Louisiana.Approval was obtained by Xavier University of Louisiana's Institutional Review Board.All students who are currently enrolled at Xavier University of Louisiana were eligible for the study.Faculty, staff, and other members of the community were excluded from this study.

Statistical Analysis
SPSS was used to analyze data in order to assess the utilization of mental health resources amongst students on an HBCU campus.

Results
159 participants were included in this study.68 of the students were under 21 years of age, while 91 of the students were 21 years of age or older.85.53% (136) of the participants were female and 13.84% (22) were male. 1 participant responded as non-binary.60.24% (100) of the students were Black or African American, while 25.90% (43) were White American, 9.64% (16) were Asian, and 1.20% (2) were American Indian/Alaska Native.3.01% (5) chose not to disclose race.86.54% (135) of the students were also non-Hispanic or Latino, with 9.64% (15) being Hispanic or Latino.3.85% (6) chose not to disclose ethnicity.The classi cation of participants within the study was spread throughout each level, with it being split between 87 graduate students and 72 undergraduate students and having a p-value of less than 0.05.
Participants had the option to describe the barriers they faced to utilization of mental health resources through a multiple-choice style question, as well as an "other" box to type their response.The following answers resulted from this question.39 students chose not to answer.12 students answered that there was concern regarding judgement if resources were utilized.62 students answered that they did not feel resources were needed at the time.40 students answered that they were not aware of current available resources.64 students answered that they felt a time constraint.5 students speci ed other reasons.Other reasons included that they convinced themselves the resources were for people with bigger problems, there was a language barrier, they have tried to use resources before and they did not help, as well as there being a lack of money and they did not feel like sitting down to talk about their feelings.
Another question in the survey asked participants what forms of coping mechanisms they found most bene cial to them.115 participants prefer to speak to friends and/or family members.65 participants prefer to handle the situation on their own.32 prefer to utilize mental health resources.13 participants prefer not to disclose.3 participants speci ed other methods, including anxiety medication, as well as meditation, journaling, and art.
Lastly, participants were asked to rate their level of comfort in seeking help or continuing to utilize mental health resources on or off campus on a scale of 1-10.16 participants responded they were not at all comfortable, whereas 26 participants responded that they were completely comfortable.

Limitations
Limitations include a lack of a validated tool to assess utilization.Additionally, this data may not be fully representative of the population on campus.As some students may not feel comfortable in busier parts of campus, and those interested in mental health may have been more willing than others to participate in the survey.Data collected from a single institution could be re ective of factors pertaining to the institution rather than of HBCUs as a whole.Despite these limitations, this data does re ect similar rates of utilization of African American college students in other settings according to previous literature.This study is still able to illustrate the importance of future focus on mental health utilization in African American students in the HBCU setting.

Conclusions
This study shows that there are multiple barriers that have been attributed to the underutilization of mental health resources both on and off campus.According to the results of this survey, the majority of students lack time to utilize or denied the need for any mental health resources.Further research should be conducted regarding the association between classi cation and comfort level.Further research could also be done to gather the best way to promote the various mental health resources that are available that could bene t different individuals.These results will allow for an opportunity to improve utilization of both on and off-campus mental health resources.

Declarations
Declaration of Interest Statement: The authors report no con icts of interest.The authors alone are responsible for the content and writing of this article

Author Contribution
Ahlam Ayyad contributed to the conception of the study, study design, data analysis, and rst manuscript draft preparation.Thomas Maestri was a research mentor that assisted in every step of the process.Savannah Harris, Nina Casanova, and Hanan Ibrahim contributed to the literature review, survey administration, and manuscript drafts.All authors commented and revised the manuscript and gave the nal approval.

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Table 1
These statistics are consistent with the demographics of the University at study being mostly African American female students.Of the 159 surveys completed, 13 responded they have used mental health resources on campus.Approximately 61.5% (8/13) are satis ed or very satis ed with the services.29 responded they have used off campus mental health resources.Approximately 41.4% (12/29) are satis ed or very satis ed with the services.62 (39%) responded that time constraint was a barrier faced in utilizing mental health resources.60 (38%) responded that they did not feel that mental health resources were currently needed.40 (25%) responded that they were not aware of the mental health resources available.There is a signi cant association between classi cation and comfort level continuing to utilize mental health resources on or off campus (p = 0.02).